Provider Demographics
NPI:1154526721
Name:LIGHTHOUSE COUNSELING & LIFE SKILLS CENTER
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING & LIFE SKILLS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BALES
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:423-499-9335
Mailing Address - Street 1:105 LEE PARKWAY DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6708
Mailing Address - Country:US
Mailing Address - Phone:423-499-9335
Mailing Address - Fax:423-499-9334
Practice Address - Street 1:105 LEE PARKWAY DR
Practice Address - Street 2:SUITE H
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6708
Practice Address - Country:US
Practice Address - Phone:423-499-9335
Practice Address - Fax:423-499-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty